Provider Demographics
NPI:1376799684
Name:FUENTES, MONIQUE F (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:F
Last Name:FUENTES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 WINSTON LN
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7400
Mailing Address - Country:US
Mailing Address - Phone:904-635-7393
Mailing Address - Fax:
Practice Address - Street 1:CAMELLIA AT DEERWOOD
Practice Address - Street 2:10061 SWEETWATER PARKWAY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3225
Practice Address - Country:US
Practice Address - Phone:904-519-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11535225100000X
GAPT0083982251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist